放化疗序贯治疗晚期鼻咽癌的前瞻性研究

目的 观察放、化疗联合治疗晚期鼻咽癌的疗效.方法 2000年4月～2001年4月,84例晚期鼻咽癌患者随机分为单纯放疗组(单放组)和放疗加化疗组(综合组).每组42例,单放组采用加速器6 MV-X线加9-12 MeV电子线照射,鼻咽中平面剂量70 Gy,颈部根治剂量70 Gy,颈部预防剂量50 Gy.综合组除接受上述处理外还接受顺铂(DDP)加5-氟脲嘧啶(5-FU)化疗6周期,第1、2周期化疗在放疗前进行,放疗结束后1周,再行第4～6周期化疗.结果 综合组新辅助化疗的有效率为85.7%,近期肿瘤消退率单放组为71.4%,综合组为90.5%,综合组高于单放组;随访5年期间,远处转移率综合组为23.8%,单放组为47.6%,以单放组为高;出现远处转移的平均时间综合组为20.4个月,单放组为7.9个月,综合组出现得较迟;5年无病生存率综合组高于单放组,差异有显著性(均P＜0.05);5年总生存率差异无显著性(P＞0.05).两组病例均未出现严重毒副反应.结论 DDP 5-Fu能提高晚期鼻咽癌患者的肿瘤近期消退率、无病生存率,未明显提高总生存率.毒副反应可以耐受,值得临床推荐使用.

A Prospective Randomized Study of Sequential Therapy of Chemotherapy and Radiotherapy in Advanced Nasopharyngeal Carcinoma

Objective A prospective randomized trial was conducted to compare chemoradiotherapy against radiotherapy alone in the treatment of locoregionally advanced nasopharyngeal carcinoma. Methods Between April 2000 and April 2001,84 patients with histologically proven advanced nasopharyngeal carcinoma were radiotherapy alone(RT group) and chemotherapy plus radiotherapy(combination group).There was fourty-two patients in each group.All patients received radical radiotherapy to the nasopharynx and neck.Planned RT was 2 Gy/day fraction to 70 Gy to the primary tumor,with 50 and 70 Gy to the node negative and to palpable nodes,respectively.The combination group received two cycles of induction chemotherapy with cisplatin and 5-fluorouracil before radical radiotherapy, and four cycles of postradiotherapy chemotherapy.Results The overall response rate to neoadjuvant chemotherapy was 85.7%.The overall complete response rate to chemoradiotherapy was 90.5%,and to radiotherapy alone,71.4%.At a follow-up of 5 years,23.8% of patients in combination group and 47.6% in RT group developed distant metastases.Time of distant metastases was 20.4 months in combination group and 7.9 months in combination group.The 5-year disease-free survival rates were higher in combination group.This finding was statistically significant(all P<0.05).The 5-year overall survival rates were not significantly different between the two arms(P>0.05).There were not serious toxicities in the two arms.Conclusion Chemotherapy with DDP and 5-FU in advanced nasopharyngeal carcinoma can improve overall response rate and disease-free survival rates.The overall survival was not significant benefit.This regimen was well tolerated.Induction chemotherapy followed by alternating chemo-radiotherapy is feasible and worth to be recommended in clinic.